For the first few minutes of tonight’s ninth season premiere of Grey’s Anatomy, I was convinced we were in the midst of another alterna-reality episode of the ABC soap. My brain knew otherwise, of course, but remember when they did that oddly intriguing and oddly weird “What If?” episode last season? Yep, this return to the Grey’s world felt so different that it was reminiscent of the feeling that episode exuded.

So many things were weird: Lexie was dead! There were new interns and residents! Cristina was away working in Minnesota! Karev was headed to Johns Hopkins! There was no sign of Kepner or Arizona! Bailey was deliriously happy! Derek and Callie were shattered with grief! Meredith was tearing around the hospital as the new Bailey/Nazi, nicknamed “Medusa”! Sloan was laying there on life support! Sorry for all the exclamation marks, but they seemed rather necessary, considering how dire all of these things are. Is this the Seattle Grace we left last May when a huge portion of our beloved doctors were stranded after their plane crashed in Idaho? Nope, not exactly — in fact, not at all. Clearly, lots had changed, making this an intriguing hour of television.

Granted, while many things had changed as we zeroed back into Seattle Grace Mercy West after a summer away, some were exactly the same. Like, say, how Meredith opened the hour with her patented monologue that cut right to the chase. “Dying changes everything,” Meredith began, foreshadowing the grim hour to come. “The world just keeps on going…without you.” Meredith was surely referencing the death of her sister Lexie, who died under a chunk of a plane in May’s finale, plus another death to come in this hour, that of Mark Sloan, who was lying in a hospital bed, on life support, presumably after his internal injuries from the finale’s plane crash got the best of him. And that’s probably where we should start.

Because it would never be any other way on a show as sudsy as Grey’s, creator Shonda Rhimes decided to kill Mark Sloan — also known lovingly as McSteamy, due to his shower-steam-and-towel introduction to Grey’s in season 2 — in an excruciating and melodramatic way. At the top of the hour, a deadline was set: 5 p.m. We viewers didn’t know exactly what the deadline was for, but it wasn’t hard to guess, especially after we learned that the life-supported and unresponsive Sloan had a directive in his living will, spelling out that “if after 30 days, there were no signs of recovery,” Richard Webber said, “Mark wanted to be let go.” And then he added: “That’s all we’re doing. Honoring his wish.”

The weird thing about it whole situation, of course, was the fact that we didn’t know how Sloan got to this devastatingly injured point. So his internal injuries must have gotten worse from what we’d seen in the finale? But how exactly? What happened out there in the wilds after last May’s finale cut off? It must have been bad if a guy as strong as Sloan couldn’t survive — or his injuries must have been just that bad and we didn’t know it.